Global Health and Tuberculosis

Introduction

We offer the trainee unique opportunities for global health research and clinical rotations. We offer many options for international research on a range of diseases including HIV/AIDS, tuberculosis, malaria, pediatric pneumonia, meningitis, neonatal sepsis, and neglected tropical diseases. Faculty in our section have longstanding international research studies in active field sites in Africa, Asia, and South America. Many of these faculty members have joint appointments in the Boston University Department of Global Health located at the Boston University School of Public Health.

Program Goals:

  • Train world-class scientists in clinical or laboratory-based research to become independent investigators in an academic setting
  • Develop expert clinician investigators who can become leaders in the field of global health and tuberculosis.

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Overview

Fellows interested in global health and tuberculosis will have the opportunity to work with faculty who have established research activities throughout the world.  The fellow will have many clinical opportunities, both seeing patients with diseases more often found in low-resourced settings that present to BMC and to travel to sites for medical work.  Those who elect to pursue a global health career as a grant-funded investigator will work closely with mentors to secure funding for a third and possibly fourth year of research training, during which time they will develop advanced skills and prepare an NIH career development award proposal.

Year One

During the first year, fellows rotate through the infectious disease consult and inpatient services similar to the other trainees in the program.  Elective time in the first year will be dedicated to applying for funding in the second year of fellowship.  During this time, fellows will be expected to meet regularly with their identified mentor(s).  This time will be dedicated to gaining a greater understanding of the research of interest and starting to accumulate preliminary data and any necessary ethics approval for future grant applications.

 Year Two

During the second year, trainees’ primary responsibility will be working on their research project and applying for independent funding; they will continue with one outpatient clinic session and complete remaining inpatient consult service duties.  Fellows may elect to do additional clinical activities relevant to this track.  A 2-4 week elective in Uganda or Brazil can be an enriching way to gain hands on, practical experience with the disease and populations of interest.  In addition, fellows can choose to participate in the ambulatory experience for tropical and travel medicine, for refugee care, and TB Clinic. The tropical and travel medicine rotation includes an opportunity for in-depth experience managing patients with Chagas disease including screening, detailed baseline evaluation for cardiac and gastrointestinal complications, and managing patients undergoing treatment.

Year Three

Fellows will devote 100% of their time to their research efforts. The primary goal of the third year is to complete and publish ongoing work such that the fellow is in an outstanding position to apply for an NIH career development award, or similar foundation funding.

The Fogarty Global Health Training Program offers opportunities in global health research training for post-doctoral candidates (i.e. individuals completing their ID fellowship) from the U.S. and lower-middle-income countries (LMICs). Boston University is part of a consortium of four universities (Harvard University, Boston University, Northwestern University, and University of New Mexico) that is sponsored by the Fogarty International Center (FIC) and several collaborating Institutes and Centers at the National Institutes of Health (NIH). The program supports specific areas of interest in HIV/AIDS, non-communicable diseases, mental health, and maternal and child health and nutrition. For more information, please contact Davidson Hamer (BU site PI) or  look at the consortium website.

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Potential Projects

Our faculty collaborate with the following international institutions:

The Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) in Pudicherry, India. Investigators from Boston University Medical Center, JIPMER and Rutgers University are conducting a number of studies in Puducherry and Tamil Nadu in Southern India. These include 1. A household contact study of 1000 pulmonary tuberculosis (TB) patients and 1500 of their household contacts to identify biomarkers that predict TB treatment failure and likelihood of developing TB among household contacts. The study also examines how comorbidities (diabetes mellitus, tobacco use, alcoholism, helminth infections and others) affect these biomarkers and risks. 2. A study of TB in pregnancy – how pregnancy affects diagnostic testing for latent TB as well a pharmacokinetics of TB drugs. 3. The TB LION (TB Learning the Impact of Nutrition) study to understand the impact of malnutrition and parasites on risk of TB disease among household contacts of TB patients – and to evaluate the impact of feeding and deworming on the ability to control Mycobacterium tuberculosis. 4. A study of the drivers of TB stigma and potential interventions to reduce TB stigma. 5. A study of the impact of iron-deficiency on TB risk. 6. A lab-based study to identify screening tests for TB. 7. A study of nasal microbiome sampling as a diagnostic tool for TB

Muhumbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania. Boston University and Dartmouth Medical School have partnered with MUHAS to develop a TB clinical trials unit at MUHAS. This partnership extends to the MUHAS school of Public Health, where BU and Dartmouth are assisting with curriculum and faculty development

Stellenbosch University, University of Cape Town, and the South African Medical Research Council in Cape Town, South Africa. There are a number of ongoing research collaborations in the Western Cape Province, South Africa. These projects include an ongoing collaboration with the South African National Health Laboratory Services to use routinely-collected province-wide laboratory data to investigate the spatiotemporal distribution of drug-resistant tuberculosis and investigate drivers of drug resistance and potentially modifiable factors. An ongoing prospective cohort study (TRUST, PI: Dr. Karen Jacobson) is also investigating the impact of problem alcohol use on tuberculosis treatment response, aiming to demonstrate that the association between alcohol use and poor treatment outcome persists independent of treatment adherence. The cohort study also aims to evaluate the effect of problem alcohol use on the pharmacokinetics/pharmacodynamics of TB drugs.

Health Economics and Epidemiology Research Office (HE2RO), a Division of the Wits Health Consortium, University of the Witwatersrand, in Johannesburg, South Africa. HE2RO and its partner organizations have more than 15 years of experience in identifying, developing, and evaluating innovations aimed at improving the South African response to the HIV and TB epidemics in the setting of the world’s largest ARV roll-out in the epicenter of the HIV/AIDS epidemic. There are many potential opportunities to work with faculty members affiliated with HE2RO and the Department of Global Health at the BU School of Public Health. This organization has expertise in both health economics and epidemiologic outcomes evaluations and conduct rigorous, quantitative cost, cost-effectiveness, and epidemiological analysis of high priority questions, often at the direct request of the National Department of Health (NDoH) and other government agencies. Our purpose is to conduct applied, policy- and program-relevant research and evaluation on issues of public health importance, and in particular on interventions to address HIV, TB, and related problems.

The Zambia Center for Applied Health Research and Development (ZCAHRD) in Lusaka, Zambia.  The Boston University-based and Zambia-based teams have developed several portfolios of work in Zambia through funding primarily from the United States Centers for Disease Control and Prevention (CDC), the United States Agency for International Development (USAID), the Bill and Melinda Gates Foundation, Department for International Development, Merck for Mothers, Grand Challenges Canada, and the National Institutes of Health (NIH). Recently completed and ongoing research projects have integrated training opportunities for DrPH, PhD, and MPH candidates from the Boston University School of Public Health and the Tufts University Friedman School of Nutrition Science and Policy.

The HBNU consortium global health fellowship is a Fogarty International Center training grant that provides mentored research opportunities to train and prepare a new cadre of health professionals in the US and LMICs in global health research by enhancing the trainees’ ability to independently plan, implement, and assess innovative clinical or operations research focused on reducing mortality and morbidity associated with HIV/AIDS and associated co-infections, as well as in the field of maternal, newborn and child health.

International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) is a long term research center on maternal, newborn and child health in Dhaka, Bangladesh. Dr. Hamer is involved in a large study of prebiotics and probiotics to prevent neonatal sepsis in collaboration with the Hospital for Sick Kids (Toronto, Canada) and the Child Health Research Foundation. In addition, there are opportunities for research on water, sanitation, hygiene and antimicrobial resistance through Dr. Hamer’s collaborations at the icddr,b.

ID faculty affiliated with Boston University School of Public Health participate in TB research through four Federally-funded research networks, the Tuberculosis Trials Consortium (TBTC), the Tuberculosis Epidemiologic Studies Consortium, both supported by the CDC and the TB Research Unit (TBRU), and RePORT India, funded by NIH. These consortia design and conduct clinical trials of new drugs and regimens for the treatment and prevention of TB and perform Epidemiologic studies of TB disease and Latent TB Infection (LTBI).

Investigators are also performing the PREEMPT Study, a multicenter prospective observational cohort study to identify the causes of emergence of resistance during therapy for treatment of MDR-TB, with study sites in India and Brazil and South Africa (funded by NIH). Through RePORT India, the Department is participating in an observational cohort study of TB in India, and through TBRU, we are participating in a household contact study of TB transmission in South Africa.

BUSPH has also partnered with Boston Medical Center and Brown/Lifespan in the Providence/Boston Center for AIDS Research (CFAR, founded by NIH), with a Scientific Working Group that addresses TB/HIV co-infection.

Participating Faculty

Nahid Bhadelia, MD, MA – Associate Professor, Boston University School of Medicine; Medical Director of Special Pathogens Unit (SPU) at Boston Medical Center (Emerging pathogens)

Tara Bouton, MD, MPH – Assistant Professor, Boston University School of Medicine (Tuberculosis)

Jerrold Ellner MD – Adjunct Professor, Boston University School of Medicine, Dept of Medicine (TB, TB & HIV)

Christopher Gill, MD –  Associate Professor, Boston University School of Public Health, Dept of Global Health (child survival, tuberculosis, pneumococcal and meningococcal disease)

Davidson Hamer MD – Professor, Boston University School of Public Health, Dept of Global Health (Tropical infectious diseases) and Boston University School of Medicine, Dept of Medicine, Infectious Diseases

Pat Hibberd, MD – Chair and Professor Boston University School of Public Health, Dept of Global Health. Professor of Medicine, Boston University School of Medicine, Dept of Medicine, Infectious Diseases.

Natasha Hochberg MD MPH – Associate Professor, Boston University School of Medicine, Dept of Medicine, Infectious Diseases; Department of Epidemiology at BU School of Public Health (Impact of malnutrition and parasitic disease on tuberculosis (TB), tropical diseases in immigrant populations)

Robert Horsburgh MD – Professor of Epidemiology, Boston University School of Public Health, Dept of Epidemiology & Department of Biostatistics (Tuberculosis, nontuberculous mycobacterial infections and opportunistic infections in AIDS)

Karen Jacobson, MD, MPH, – Assistant Professor, Boston University School of Medicine, Dept of Medicine, Infectious Diseases; Boston University School of Public Health, Department of Epidemiology; (Epidemiology of drug resistant tuberculosis, improving TB outcomes in resource-limited settings)

Gerald Keusch, MD – Professor of Medicine and International Health at Boston University Schools of Medicine and Public Health; Associate Director of the National Emerging Infectious Diseases Laboratory Institute.

Donald Thea MD MSc  Professor, Boston University School of Public Health, Dept of Global Health (Perinatal transmission of HIV)

Carlos Jesus Acuna-Villaorduna, MD – Assistant Professor of Medicine, Boston University School of Medicine

 

Websites:

Makerere University Infectious Diseases Institute (IDI)

Núcleo de Doenças Infecciosas (NDI)

Fogarty Global Health Training Program 

Health Economics and Epidemiology Research Office (HE2RO)